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Re: Gyn: OCPs From: Betsy Hyde (elishyde@connix.com) Thu Aug 27 17:54:11 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Betsy Hyde: "Re: OB:Home Births in Australia" Previous message: Peter Wein: "Re: OB:Home Births in Australia" Maybe in reply to: John Robertson M.D.: "Gyn: OCPs" Next in thread: Gail Waldby, MD: "Re: Gyn: OCPs" > >Clearly a different league of estrogen dosing however as contrasted with >OCPs. I was never trained to discontinue OCPs and am not aware of any data >to say that it makes a difference so I would disagree with an earlier >posters "flabergasted" tone. Perhaps the fact that I spent many years my life prior to midwifery doing research (and publishing extensively) on venous thromboembolic disease makes me more aware of the literature on oral contraceptives and post-op venous thromboembolic disease. My post did not address itself to minor gyn surgery. It referred to women undergoing major orthopedic surgery and/or fractures, and whose orthopedists did not have them discontinue their oral contraceptives, even though they were placed on coumadin. A recent review article addresses this issue. (Weinmann EE and Salzman EW. Medical Progress: Deep Vein Thrombosis. N Engl J Med 331(24):1630-1641, 1994. The authors state: >Prevention of Venous Thromboembolism > >The goal of prophylactic therapy in patients with risk factors for >deep-vein thrombosis is to prevent both its occurrence and its >consequences, pulmonary emboli and the postphlebitic syndrome. Affected >patients often have no symptoms, and the detection of deep-vein thrombosis >is therefore apt to be delayed. Of the patients who will eventually die of >pulmonary emboli, two thirds survive less than 30 minutes after the event, >not long enough for most forms of treatment to be effective (Ref. 153). >Preventing deep-vein thrombosis in patients at risk is clearly preferable >to treating the condition after it has appeared, (Ref. 154) a view that is >supported by cost-effectiveness analysis (Ref. 154-157). The presence of >clinical risk factors identifies patients with the most to gain from >prophylactic measures, (Ref. 158) as well as patients who should receive >antithrombotic prophylaxis during periods of increased susceptibility, >such as postoperatively or post partum. >Risk factors may combine synergistically to increase the incidence of >venous thromboembolism in various circumstances (Table 3). At one extreme, >the risk of deep-vein thrombosis in the course of daily activities may be >so low that no specific preventive measures are necessary. A patient at >low risk needs only minimal prophylactic measures, such as early >ambulation after surgery and the use of elastic stockings, augmenting the >propulsion of blood from ankle to knee (Ref. 159,160). > >The risk may be much higher in a patient older than 40 years of age who is >undergoing an operation that lasts longer than an hour, who has congestive >heart failure, who has been taking an oral contraceptive, or who has had >multiple traumatic injuries. Unless prophylactic measures are used, the >incidence of deep-vein thrombosis can exceed 60 percent (Ref. 2,55) after >an orthopedic operation on the lower extremities, especially if there is a >lengthy convalescence involving bed rest (Ref. 55). During a total hip >replacement, mechanical trauma to the femoral or iliac veins, (Ref. 161) >thermal damage from the heat of polymerization of the acrylic cement, >(Ref. 162) and a possible chemical effect of circulating absorbed monomer >contribute to the hazard. So, I do remain flabbergasted (it is a real word, "to overwhelm with shock, surprise or wonder: astound) that orthopedists would put someone on coumadin for 3 months, but leave them on OCPs during a prolonged period of immobility following a hip replacement or femoral fracture. -- Betsy Hyde CNM Branford, CT Next message: Betsy Hyde: "Re: OB:Home Births in Australia" Previous message: Peter Wein: "Re: OB:Home Births in Australia" Maybe in reply to: John Robertson M.D.: "Gyn: OCPs" Next in thread: Gail Waldby, MD: "Re: Gyn: OCPs"

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